3 research outputs found
Liposomal Bupivacaine in Total Knee Arthroplasty: Preliminary Results of a Two-Surgeon, Retrospective Study
INTRODUCTION: Liposomal bupivacaine (LB) is a slowly degrading preparation that provides local anesthesia for up to 72 hours. It targets the site directly responsible for pain sensation, with no associated motor blockade. In total knee arthroplasty (TKA), it may have superior outcomes to anesthesia with regional nerve block.
METHODS: Our surgeons began using LB in TKA patients in 2013. All patients following each surgeon’s LB start date were the experimental group. An equivalent number of patients prior to 2013 served as the control group. All control group patients received a preoperative femoral nerve block, and all experimental group patients received peri- and intra-articular LB, delivered intraoperatively. All other surgical and anesthesia interventions were the same. We used retrospective chart review to identify patient demographics, time to first ambulation, time to discharge, and incidence of postoperative nausea and vomiting. We also recorded opioid consumption intraoperatively, in the recovery room, and on the floor.
RESULTS: There were 161 patients in each group. We found no significant difference between the two groups with regard to gender, age, weight, preoperative opioid exposure, side of procedure, type of anesthesia (general vs. spinal), or ASA status. On average, LB patients consumed 29.2% less opioid after leaving the recovery room (p
DISCUSSION AND CONCLUSION: With increasing focus on the cost of TKA, there is strong incentive to manage costs associated with the procedure. Additionally, all patients, regardless of comorbid conditions, can benefit from limited exposure to narcotic pain medication. Our results indicate that LB decreases total systemic opioid requirement, time to first ambulation, and time to discharge from the hospital
Total Joint Replacement Prehabilitation: A Feasibility Study
Objectives: Pre-operative physical therapy has been shown to reduce post-acute care service utilization. Shifting rehabilitation to the presurgical period, referred to as prehabilitation, could result in reduced recovery time and cost. Limited access to physical therapy may prevent patients from achieving the benefits, and a standard set of independent exercises may be an alternative. We aim to assess the feasibility of an independent exercise program as a pre-surgical intervention for total hip and knee replacement.
Design: Participants were taught two exercises for hip or knee arthritis at least one week prior to surgery and instructed to perform them independently at home. Subjects were contacted three days to one month post-operatively and surveyed about discharge, frequency of exercise, and living status of alone or with others. No adverse effects were reported. Additional information was collected from the subjects’chart including age, BMI, and sex. Discharge outcomes were compared with pre-existing independent factors using univariate and multivariate analyses.
Results: A total of 80 subjects were followed with a home discharge rate of 78.75%. Univariate analyses showed that the presence of other people in the home showed a slight, but non-significant, association with differences of discharge destination. 82.1%-83.3% of patients who live with others were discharged home versus 57.1% of patients living alone (LR chi-square: 3.84, p=0.15). Multivariate analyses showed a slight, but non-significant, association between frequency of prehabilitation and discharge destination (OR=1.212; 95% CI, 0.960-1.530). BMI showed no associated difference in discharge destination.
Conclusions: Increased frequency of prehabilitation and presence of others at home showed slight associations with increased discharges to home, but were non-significant. Increased exposure to prehabilitation (duration times frequency) trends toward more frequent home discharge. Independently performed prehabilitation may be offered as an alternative pre-surgical intervention with likely little to no adverse effect. Larger numbers are needed to determine likelihood of discharge home